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Narumoto K, Endo M, Kaneko M, Iwata T, Inoue M. Japanese primary care physicians' postpartum mental health care: A cross-sectional study. J Gen Fam Med 2024; 25:224-231. [PMID: 38966647 PMCID: PMC11221064 DOI: 10.1002/jgf2.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 07/06/2024] Open
Abstract
Background Postpartum mental health care is a public health priority requiring interprofessional and interorganizational collaboration. Primary care physicians (PCPs) have the potential to play an essential role in facilitating access to health care and providing comprehensive and coordinated care for postpartum mental health problems. In Japan, however, there are no previous studies on the extent to which PCPs are involved in postpartum mental health care. Therefore, this study aimed to investigate the practices and experiences of Japanese PCPs in providing such care. Methods This study presents a subset of the findings from a cross-sectional study using an online questionnaire on postpartum care among Japanese PCPs. We employed descriptive analysis to examine their practices and experiences in providing general and postpartum mental health care. Results We received 339 valid responses from 5811 PCPs. The median proportion of the outpatients with mental health problems that PCPs regularly saw was 15%. Approximately two out of three PCPs (68.7%) reported routinely performing screening for depression and anxiety. Seventy-six percent of PCPs had the opportunity to provide care for postpartum women. Approximately one in two PCPs (47.8%) had managed cases of postpartum mental health problems and collaborated with various professionals and resources to provide care. Conclusions The majority of Japanese PCP participants in the study provide mental health care and have managed cases of postpartum mental health problems, collaborating with various health professionals.
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Affiliation(s)
- Keiichiro Narumoto
- Department of Family and Community MedicineHamamatsu University School of MedicineHamamatsuJapan
| | - Miho Endo
- Department of Palliative Care, Public Interest Foundation Corporation LifeExtension Laboratory Attached Eiju General HospitalDaitokuJapan
| | - Makoto Kaneko
- Department of Health Data ScienceYokohama City UniversityYokohamaJapan
| | - Tomoko Iwata
- Department of Obstetrics and Gynecology and Family MedicineHamamatsu University School of MedicineHamamatsuJapan
| | - Machiko Inoue
- Department of Family and Community MedicineHamamatsu University School of MedicineHamamatsuJapan
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Executive summary: Workshop on maternal mental health, February 11-12, 2024, co-sponsored by the American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2024; 231:B2-B6. [PMID: 38604469 DOI: 10.1016/j.ajog.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
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Al Ahbabi S, Mubarak G, Al Khaldi S, Bin Mousa A, Mohammad Baynouna Al Ketbi L. Prevalence of Postpartum Depression among Mothers in the Emirates of Abu Dhabi. Matern Child Health J 2024:10.1007/s10995-024-03931-5. [PMID: 38951298 DOI: 10.1007/s10995-024-03931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Postpartum depression (PPD) is a common mental health condition that affects women in a silent and covert way and is not clearly visible to the community or to health care providers. Untreated PPD has significant and long-term consequences on the mother and their child. This study aims to assess the risk of postpartum depression among women in the Emirate of Abu Dhabi and its determinants. METHOD This is a questionnaire-based cross-sectional study conducted at primary healthcare centers in the Emirate of Abu Dhabi. The target population is women visiting the well-child vaccination clinics for their infants' vaccination. The questionnaire used consisted of socio-demographic characteristics, important histories such as obstetric, medical, and social histories, and the Edinburgh Post Partum depression scale EPPS. EPPS is a validated tool used to evaluate the probability of postpartum depression. RESULTS The probability of postpartum depression for women visiting the well child care clinics in the Emirate of Abu Dhabi during the study period was 35%, One-third. 10% had high risk, 7% had moderate risk, and 18% had mild risk. Using logistic and linear regression, there was an association identified between postpartum depression risk and the presence of weight concern and employment status OR 5.499(2.618-11.548) and OR 0.483 (0.246-0.951), respectively (P < 0.005). From the total sample, 3.7% responded quite often or sometimes to the question of having the intention to harm themselves. CONCLUSION EPDS is recommended to be used routinely to screen women in the postnatal period. This high prevalence of risk of postpartum depression in the UAE (One in three women) calls for a well-prepared healthcare system and community. Healthcare providers need to be prepared with better knowledge, practice, and management strategies to care for these women, for early identification and management. Further studies should be undertaken to achieve effective strategies to reduce the incidence of this condition.
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Affiliation(s)
- Salma Al Ahbabi
- Abu Dhabi Healthcare Services, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
| | - Ghada Mubarak
- Abu Dhabi Healthcare Services, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
| | - Sharifa Al Khaldi
- Abu Dhabi Healthcare Services, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
| | - Ali Bin Mousa
- Abu Dhabi Healthcare Services, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
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Dennis CL, Singla DR, Brown HK, Savel K, Clark CT, Grigoriadis S, Vigod SN. Postpartum Depression: A Clinical Review of Impact and Current Treatment Solutions. Drugs 2024; 84:645-659. [PMID: 38811474 DOI: 10.1007/s40265-024-02038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
Depression during the first year postpartum (postpartum depression) impacts millions of women and their families worldwide. In this narrative review, we provide a summary of postpartum depression, examining the etiology and consequences, pharmacological and psychological treatments, and potential mechanisms of change and current barriers to care. Psychological treatments are effective and preferred by many perinatal patients over medications, but they often remain inaccessible. Key potential mechanisms underlying their effectiveness include treatment variables (e.g., dosage and therapeutic alliance) and patient behaviors (e.g., activation and avoidance and emotional regulation). Among pharmacological treatments, the selective serotonin reuptake inhibitor (SSRI) sertraline is generally the first-line antidepressant medication recommended to women in the postpartum period due to its minimal passage into breastmilk and the corresponding decades of safety data. Importantly, most antidepressant drugs are considered compatible with breastfeeding. Neurosteroids are emerging as an effective treatment for postpartum depression, although currently this treatment is not widely available. Barriers to widespread access to treatment include those that are systematic (e.g., lack of specialist providers), provider-driven (e.g., lack of flexibility in treatment delivery), and patient-driven (e.g., stigma and lack of time for treatment engagement). We propose virtual care, task-sharing to non-specialist treatment providers, and collaborative care models as potential solutions to enhance the reach and scalability of effective treatments to address the growing burden of postpartum depression worldwide and its negative impact on families and society.
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Affiliation(s)
- Cindy-Lee Dennis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Rm 280, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Daisy R Singla
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Katarina Savel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Crystal T Clark
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Sophie Grigoriadis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
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Liu Y, Joly R, Reading Turchioe M, Benda N, Hermann A, Beecy A, Pathak J, Zhang Y. Preparing for the bedside-optimizing a postpartum depression risk prediction model for clinical implementation in a health system. J Am Med Inform Assoc 2024; 31:1258-1267. [PMID: 38531676 PMCID: PMC11105144 DOI: 10.1093/jamia/ocae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE We developed and externally validated a machine-learning model to predict postpartum depression (PPD) using data from electronic health records (EHRs). Effort is under way to implement the PPD prediction model within the EHR system for clinical decision support. We describe the pre-implementation evaluation process that considered model performance, fairness, and clinical appropriateness. MATERIALS AND METHODS We used EHR data from an academic medical center (AMC) and a clinical research network database from 2014 to 2020 to evaluate the predictive performance and net benefit of the PPD risk model. We used area under the curve and sensitivity as predictive performance and conducted a decision curve analysis. In assessing model fairness, we employed metrics such as disparate impact, equal opportunity, and predictive parity with the White race being the privileged value. The model was also reviewed by multidisciplinary experts for clinical appropriateness. Lastly, we debiased the model by comparing 5 different debiasing approaches of fairness through blindness and reweighing. RESULTS We determined the classification threshold through a performance evaluation that prioritized sensitivity and decision curve analysis. The baseline PPD model exhibited some unfairness in the AMC data but had a fair performance in the clinical research network data. We revised the model by fairness through blindness, a debiasing approach that yielded the best overall performance and fairness, while considering clinical appropriateness suggested by the expert reviewers. DISCUSSION AND CONCLUSION The findings emphasize the need for a thorough evaluation of intervention-specific models, considering predictive performance, fairness, and appropriateness before clinical implementation.
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Affiliation(s)
- Yifan Liu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, United States
| | | | - Natalie Benda
- Columbia University School of Nursing, New York, NY, United States
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, United States
| | - Ashley Beecy
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, United States
- NewYork-Presbyterian Hospital, New York, NY 10065, United States
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, United States
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
- NewYork-Presbyterian Hospital, New York, NY 10065, United States
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Wisner KL, Murphy C, Thomas MM. Prioritizing Maternal Mental Health in Addressing Morbidity and Mortality. JAMA Psychiatry 2024; 81:521-526. [PMID: 38381408 DOI: 10.1001/jamapsychiatry.2023.5648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Importance The rate of maternal mortality in the United States is 2-fold to 3-fold greater than that in other high-income countries. While many national initiatives have been developed to combat maternal mortality, these efforts often fail to include mental illness. Objective To highlight the underrecognized contribution of mental illness to maternal mortality, which is nearly double that of postpartum hemorrhage. Evidence Review A topic outline was developed to include challenges in measuring perinatal mental conditions and mortality rates; contributions of social determinants of health to mental conditions and mortality; perinatal psychiatric disorder characterization; mechanisms by which maternal mental illness increases mortality, specifically, suicide and addictive disorders; access limitations and care "deserts"; prenatal stress and its impact on reproductive outcomes; increasing clinician expertise through cross-disciplinary education; intervention sites and models; and asserting that mental health is fundamental to maternal health. Publications in the last 3 years were prioritized, particularly those relating to policy. References were selected through consensus. Sources were PubMed, Ovid, direct data published on government websites, and health policy sources such as the Policy Center for Maternal Mental Health. Findings Priority was given to recent sources. Citations from 2022-2023 numbered 26; within the last 5 years, 14; and historical references, 15. Recommendations to address each topic area serve as concluding statements for each section. To mitigate the contributions of mental illness to the maternal mortality risk, a coordinated effort is required across professional and governmental organizations. Conclusions and Relevance Concrete programmatic and policy changes are needed to reduce perinatal stress and address trauma, standardize the collection of social determinant of health data among perinatal patients, increase access to reproductive psychiatry curricula among prescribers, reduce perinatal mental health and obstetrical deserts, institute paid parental leave, and support seamless integration of perinatal and behavioral health care. Moreover, instead of focusing on a relatively minor portion of the contributors to health that current medical practice targets, fortifying the social foundation strengthens the prospects for the health of families for our current and future generations.
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Affiliation(s)
- Katherine L Wisner
- Developing Brain Institute, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Caitlin Murphy
- Department of Health Policy and Management, Milken Institute of Public Health, George Washington University, Washington, DC
| | - Megan M Thomas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City
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Zivin K, Courant A. Disparities in Utilization and Delivery Outcomes for Women with Perinatal Mood and Anxiety Disorders. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2024; 9:e240003. [PMID: 38817312 PMCID: PMC11138136 DOI: 10.20900/jpbs.20240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Perinatal mood and anxiety disorders (PMAD), which include depression and/or anxiety in the year before and/or after delivery, are common complications of pregnancy, affecting up to one in four perinatal individuals, with costs of over $15 billion per year in the US. In this paper, we provide an overview of the disparities in utilization and delivery outcomes for individuals with perinatal mood and anxiety disorders in the US. In addition, we discuss the current US screening and treatment guidelines as well as the high societal costs of illness of PMAD for both perinatal individuals and children. Finally, we outline opportunities for quality improvement of PMAD care in the US, including leveraging increased engagement with healthcare system during prenatal care, working toward a more cohesive national strategy to address PMAD, leaning into evidence-based policymaking through collaboration with a panel of experts, and generating state-level profiles focused on PMAD.
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Affiliation(s)
- Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Program on Women’s Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor MI 48109, USA
- VA Ann Arbor Healthcare System, Ann Arbor MI 48105, USA
| | - Anna Courant
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Wang S, Deng CM, Zeng Y, Chen XZ, Li AY, Feng SW, Xu LL, Chen L, Yuan HM, Hu H, Yang T, Han T, Zhang HY, Jiang M, Sun XY, Guo HN, Sessler DI, Wang DX. Efficacy of a single low dose of esketamine after childbirth for mothers with symptoms of prenatal depression: randomised clinical trial. BMJ 2024; 385:e078218. [PMID: 38808490 DOI: 10.1136/bmj-2023-078218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To determine whether a single low dose of esketamine administered after childbirth reduces postpartum depression in mothers with prenatal depression. DESIGN Randomised, double blind, placebo controlled trial with two parallel arms. SETTING Five tertiary care hospitals in China, 19 June 2020 to 3 August 2022. PARTICIPANTS 364 mothers aged ≥18 years who had at least mild prenatal depression as indicated by Edinburgh postnatal depression scale scores of ≥10 (range 0-30, with higher scores indicating worse depression) and who were admitted to hospital for delivery. INTERVENTIONS Participants were randomly assigned 1:1 to receive either 0.2 mg/kg esketamine or placebo infused intravenously over 40 minutes after childbirth once the umbilical cord had been clamped. MAIN OUTCOME MEASURES The primary outcome was prevalence of a major depressive episode at 42 days post partum, diagnosed using the mini-international neuropsychiatric interview. Secondary outcomes included the Edinburgh postnatal depression scale score at seven and 42 days post partum and the 17 item Hamilton depression rating scale score at 42 days post partum (range 0-52, with higher scores indicating worse depression). Adverse events were monitored until 24 hours after childbirth. RESULTS A total of 364 mothers (mean age 31.8 (standard deviation 4.1) years) were enrolled and randomised. At 42 days post partum, a major depressive episode was observed in 6.7% (12/180) of participants in the esketamine group compared with 25.4% (46/181) in the placebo group (relative risk 0.26, 95% confidence interval (CI) 0.14 to 0.48; P<0.001). Edinburgh postnatal depression scale scores were lower in the esketamine group at seven days (median difference -3, 95% CI -4 to -2; P<0.001) and 42 days (-3, -4 to -2; P<0.001). Hamilton depression rating scale scores at 42 days post partum were also lower in the esketamine group (-4, -6 to -3; P<0.001). The overall incidence of neuropsychiatric adverse events was higher in the esketamine group (45.1% (82/182) v 22.0% (40/182); P<0.001); however, symptoms lasted less than a day and none required drug treatment. CONCLUSIONS For mothers with prenatal depression, a single low dose of esketamine after childbirth decreases major depressive episodes at 42 days post partum by about three quarters. Neuropsychiatric symptoms were more frequent but transient and did not require drug intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04414943.
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Affiliation(s)
- Shuo Wang
- Department of Anaesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Chun-Mei Deng
- Department of Anaesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Yuan Zeng
- Department of Anaesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Xin-Zhong Chen
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ai-Yuan Li
- Department of Anaesthesiology, Hunan Province Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Shan-Wu Feng
- Department of Anaesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Li-Li Xu
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Liang Chen
- Department of Anaesthesiology, Hunan Province Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Hong-Mei Yuan
- Department of Anaesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Han Hu
- Department of Anaesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Tian Yang
- Department of Anaesthesiology, Hunan Province Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Tao Han
- Department of Anaesthesiology, Hunan Province Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Hui-Ying Zhang
- Department of Anaesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Ming Jiang
- Department of Anaesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Xin-Yu Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hui-Ning Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Dong-Xin Wang
- Department of Anaesthesiology, Peking University First Hospital, Beijing 100034, China
- Outcomes Research Consortium, Cleveland, OH, USA
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Hall SV, Pangori A, Tilea A, Schroeder A, Admon LK, Zivin K. Antidepressant Prescriptions Increased For Privately Insured People With Perinatal Mood And Anxiety Disorder, 2008-20. Health Aff (Millwood) 2024; 43:514-522. [PMID: 38560803 PMCID: PMC11164068 DOI: 10.1377/hlthaff.2023.01448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
We aimed to determine whether antidepressant prescriptions for perinatal mood and anxiety disorder (PMAD) increased after several professional organizations issued clinical recommendations in 2015 and 2016. This serial, cross-sectional, logistic regression analysis evaluated changes in antenatal and postpartum antidepressant prescriptions among commercially insured people who had a live-birth delivery as well as a PMAD diagnosis during the period 2008-20. For people with antenatal PMAD, the odds of an antenatal antidepressant prescription decreased 3 percent annually from 2008 to 2016 and increased by 32 percent in 2017, and the annual rate of change increased 5 percent for 2017-20 compared with 2008-16. For people with postpartum PMAD, the odds of a postpartum antidepressant prescription decreased 2 percent annually from 2008 to 2016 and experienced no significant change in 2017, but the annual rate of change increased 3 percent for 2017-20 compared with 2008-16. The clinical recommendations issued in 2015 and 2016 were associated with increased antidepressant prescriptions for PMAD, particularly for antenatal PMAD. These findings indicate that clinical recommendations represent an effective tool for changing prescribing patterns.
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Affiliation(s)
| | | | | | | | | | - Kara Zivin
- Kara Zivin, University of Michigan, Veterans Affairs Ann Arbor Healthcare System, and Mathematica, Ann Arbor, Michigan
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Counts NZ, Feinberg ME, Lee JK, Smith JD. Modeling Long-Term Budgetary Impacts of Prevention: An Overview of Meta-analyses of Relationships Between Key Health Outcomes Across the Life-Course. JOURNAL OF PREVENTION (2022) 2024; 45:177-192. [PMID: 38157132 DOI: 10.1007/s10935-023-00744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 01/03/2024]
Abstract
Budget analysis entities often cannot capture the full downstream impacts of investments in prevention services, programs, and interventions. This study describes and applies an approach to synthesizing existing literature to more fully account for these effects. This study reviewed meta-analyses in PubMed published between Jan 1, 2010 and Dec 31, 2019. The initial search included meta-analyses on the association between health risk factors, including maternal behavioral health, intimate partner violence, child maltreatment, depression, and obesity, with a later health condition. Through a snowball sampling-type approach, the endpoints of the meta-analyses identified became search terms for a subsequent search, until each health risk was connected to one of the ten costliest health conditions. These results were synthesized to create a path model connecting the health risks to the high-cost health conditions in a cascade. Thirty-seven meta-analyses were included. They connected early-life health risk factors with six high-cost health conditions: hypertension, diabetes, asthma and chronic obstructive pulmonary disorder, mental disorders, heart conditions, and trauma-related disorders. If confounders could be controlled for and causality inferred, the cascading associations could be used to more fully account for downstream impacts of preventive interventions. This would support budget analysis entities to better include potential savings from investments in chronic disease prevention and promote greater implementation at scale.
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Affiliation(s)
- Nathaniel Z Counts
- Mental Health America, 500 Montgomery St, Suite 820, Alexandria, VA, 22314, USA.
| | - Mark E Feinberg
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, USA
| | - Jin-Kyung Lee
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, USA
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Wu WR, Lee LC, Tsai CH, Hou PH. The Relationships Between Multidimensional Symptom Burden, Adaptation, and Depression During Pregnancy: A Cross-sectional Study. Clin Nurs Res 2024; 33:157-164. [PMID: 38339878 DOI: 10.1177/10547738241230125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Prenatal depression is highly prevalent, but its relationship with the multidimensional burden of physical symptoms during pregnancy remains underexplored. The aim of this study was to examine the relationship between pregnancy-related physical symptom burden, including frequency, severity, and impact on life and pregnancy adaptation to prenatal depression, and to identify predictors of depression during pregnancy. The study was cross-sectional in design. A hospital-based setting providing comprehensive maternity care services from outpatient to inpatient. The sample consisted of two hundred forty-three pregnant individuals aged 20 and above with no major obstetrical complications. Structured questionnaires including demographic and obstetrical characteristics, depression, symptom burden, and pregnancy adaptation were used for data collection. Multiple linear regression analyses were performed to identify significant predictors of depression. The study revealed that approximately 32% of the variance in depression scores could be explained by the combined effects of pregnancy-related physical symptom burden and pregnancy adaptation. Specifically, low-level pregnancy adaptation, high-level symptom impact on life, unmarried status, and mid-level symptom severity were identified as the main predictors of prenatal depression among low-risk pregnant individuals. The findings contribute to the existing knowledge base, emphasizing the significance of addressing and managing pregnancy-related physical symptom burden while promoting effective adaptation to pregnancy as a means to mitigate the risk of prenatal depression.
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Affiliation(s)
| | | | - Chin-Hsing Tsai
- Chang Gung University of Science and Technology, Gueishan, Taoyuan, Taiwan
| | - Pen-Hsin Hou
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
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Ronen K, Gewali A, Dachelet K, White E, Jean-Baptiste M, Evans YN, Unger JA, Tandon SD, Bhat A. Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study. JMIR Form Res 2024; 8:e51066. [PMID: 38306159 PMCID: PMC10873795 DOI: 10.2196/51066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. OBJECTIVE We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. METHODS IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ≤80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. RESULTS Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. CONCLUSIONS This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study's small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation.
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Affiliation(s)
- Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anupa Gewali
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Dachelet
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Erica White
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Yolanda N Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, United States
| | - S Darius Tandon
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- Center for Community Health, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Boland Z, Lloyd N, Layton H, Van Lieshout RJ. Development and Feasibility of Online 1-Day CBT-Based Workshops for Preventing Postpartum Depression. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102241. [PMID: 37839732 DOI: 10.1016/j.jogc.2023.102241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/20/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Zoe Boland
- Neuroscience Graduate Program, McMaster University, Hamilton, ON.
| | - Nancy Lloyd
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
| | - Haley Layton
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
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Matsunaga M, Okajima J, Furutani K, Kusakabe N, Nakamura-Taira N. Associations of rumination, behavioral activation, and perceived reward with mothers' postpartum depression during the COVID-19 pandemic: a cross-sectional study. Front Psychiatry 2024; 15:1295988. [PMID: 38317767 PMCID: PMC10838984 DOI: 10.3389/fpsyt.2024.1295988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction The COVID-19 pandemic has led to increased social isolation for mothers, and rumination exacerbates postpartum depression in mothers with poor social support. Although behavioral activation can help to decrease their depressive symptoms, the mechanism by which behavioral activation reduces postpartum depression remains unclear. Methods We examined the effects of rumination and behavioral activation on depression in postpartum women by examining a model mediated by subjective reward perception. A questionnaire was administered to 475 postpartum women (Age: Mean = 30.74 years, SD = 5.02) within 1 year of childbirth using an Internet survey. The measurements included perinatal depression, rumination, and behavioral activation, and we assessed environmental reward. To control for confounding variables, we assessed psychiatric history, social support, parenting perfectionism, and COVID-19 avoidance. Results Eighty-four (17.68%) mothers had possible postpartum depression. The covariance structure analysis showed that not only was there a direct positive path from rumination to postnatal depression but also a negative path via reward perception. Discussion This finding indicated that the COVID-19 pandemic could have increased depression in many of the mothers. Rumination not only directly relates to postpartum depression, but it could also indirectly relate to postpartum depression by decreasing exposure to positive reinforcers. In addition, having a history of psychiatric illness increases the effect of rumination on postpartum depression. These findings suggest that psychological interventions are needed to reduce rumination and increase contact with positive reinforcements to reduce postpartum depression, especially for high-risk groups.
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Affiliation(s)
- Miki Matsunaga
- Department of Psychology, Rikkyo University, Niiza, Japan
| | - Junko Okajima
- Department of Psychology, Rikkyo University, Niiza, Japan
| | | | - Noriko Kusakabe
- Department of Psychology, Faculty of Human Culture and Sciences, Fukuyama University, Fukuyama, Japan
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Desai PM, Harkins S, Rahman S, Kumar S, Hermann A, Joly R, Zhang Y, Pathak J, Kim J, D’Angelo D, Benda NC, Reading Turchioe M. Visualizing machine learning-based predictions of postpartum depression risk for lay audiences. J Am Med Inform Assoc 2024; 31:289-297. [PMID: 37847667 PMCID: PMC10797282 DOI: 10.1093/jamia/ocad198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/15/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES To determine if different formats for conveying machine learning (ML)-derived postpartum depression risks impact patient classification of recommended actions (primary outcome) and intention to seek care, perceived risk, trust, and preferences (secondary outcomes). MATERIALS AND METHODS We recruited English-speaking females of childbearing age (18-45 years) using an online survey platform. We created 2 exposure variables (presentation format and risk severity), each with 4 levels, manipulated within-subject. Presentation formats consisted of text only, numeric only, gradient number line, and segmented number line. For each format viewed, participants answered questions regarding each outcome. RESULTS Five hundred four participants (mean age 31 years) completed the survey. For the risk classification question, performance was high (93%) with no significant differences between presentation formats. There were main effects of risk level (all P < .001) such that participants perceived higher risk, were more likely to agree to treatment, and more trusting in their obstetrics team as the risk level increased, but we found inconsistencies in which presentation format corresponded to the highest perceived risk, trust, or behavioral intention. The gradient number line was the most preferred format (43%). DISCUSSION AND CONCLUSION All formats resulted high accuracy related to the classification outcome (primary), but there were nuanced differences in risk perceptions, behavioral intentions, and trust. Investigators should choose health data visualizations based on the primary goal they want lay audiences to accomplish with the ML risk score.
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Affiliation(s)
- Pooja M Desai
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, United States
| | - Sarah Harkins
- Columbia University School of Nursing, New York, NY 10032, United States
| | - Saanjaana Rahman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Shiveen Kumar
- College of Agriculture and Life Science University, Cornell University, Ithaca, NY 14850, United States
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medical College, New York, NY 10065, United States
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, United States
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Jessica Kim
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Deborah D’Angelo
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Natalie C Benda
- Columbia University School of Nursing, New York, NY 10032, United States
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16
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Turchioe MR, Hermann A, Benda NC. Recentering responsible and explainable artificial intelligence research on patients: implications in perinatal psychiatry. Front Psychiatry 2024; 14:1321265. [PMID: 38304402 PMCID: PMC10832054 DOI: 10.3389/fpsyt.2023.1321265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
In the setting of underdiagnosed and undertreated perinatal depression (PD), Artificial intelligence (AI) solutions are poised to help predict and treat PD. In the near future, perinatal patients may interact with AI during clinical decision-making, in their patient portals, or through AI-powered chatbots delivering psychotherapy. The increase in potential AI applications has led to discussions regarding responsible AI and explainable AI (XAI). Current discussions of RAI, however, are limited in their consideration of the patient as an active participant with AI. Therefore, we propose a patient-centered, rather than a patient-adjacent, approach to RAI and XAI, that identifies autonomy, beneficence, justice, trust, privacy, and transparency as core concepts to uphold for health professionals and patients. We present empirical evidence that these principles are strongly valued by patients. We further suggest possible design solutions that uphold these principles and acknowledge the pressing need for further research about practical applications to uphold these principles.
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Affiliation(s)
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States
| | - Natalie C. Benda
- School of Nursing, Columbia University School of Nursing, New York, NY, United States
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17
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Saeed H, Wu J, Tesfaye M, Grantz KL, Tekola-Ayele F. Placental accelerated aging in antenatal depression. Am J Obstet Gynecol MFM 2024; 6:101237. [PMID: 38012987 PMCID: PMC10843762 DOI: 10.1016/j.ajogmf.2023.101237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Antenatal maternal depression is associated with poor pregnancy outcomes and long-term effects on the offspring. Previous studies have identified links between antenatal depression and placental DNA methylation and between placental epigenetic aging and poor pregnancy outcomes, such as preterm labor and preeclampsia. The relationship between antenatal depression and poor pregnancy outcomes may be partly mediated via placental aging. OBJECTIVE This study aimed to investigate whether antenatal depressive symptoms are associated with placental epigenetic age acceleration, an epigenetic aging clock measure derived from the difference between methylation age and gestational age at delivery. STUDY DESIGN The study included 301 women who provided placenta samples at delivery as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies - Singletons that recruited participants from diverse race and ethnic groups at 12 US clinical sites (2009-2013). Women underwent depression screening using the Edinburgh Postnatal Depression Scale up to 6 times across the 3 trimesters of pregnancy. Depressive symptoms status was determined for each pregnancy trimester using an Edinburgh Postnatal Depression Scale score, in which a score of ≥10 was defined as having depressive symptoms and a score of <10 was defined as not having depressive symptoms. Placental DNA methylation was profiled from placenta samples. Placental epigenetic age was estimated using a methylation-based age estimator (placental "epigenetic clock") that has previously been found to have high placental gestational age prediction accuracy for uncomplicated term pregnancies. Placental age acceleration was defined to be the residual upon regressing the estimated epigenetic age on gestational age at delivery. Associations between an Edinburgh Postnatal Depression Scale score of ≥10 and an Edinburgh Postnatal Depression Scale score of <10 in the first, second, and third trimesters of pregnancy (ie, depressive symptoms vs none in each trimester) and placental age acceleration were tested using multivariable linear regression adjusting for maternal age, parity, race and ethnicity, and employment. RESULTS There were 31 (10.3%), 48 (16%), and 49 (16.4%) women with depressive symptoms (ie, Edinburgh Postnatal Depression Scale score of ≥10) in the first, second, and third trimesters of pregnancy, respectively. Of these women, 21 (7.2%) had sustained first- and second-trimester depressive symptoms, 19 (7%) had sustained second- and third-trimester depressive symptoms, and 12 (4.8%) had sustained depressive symptoms throughout pregnancy. Women with depressive symptoms in the second trimester of pregnancy had 0.41 weeks higher placental age acceleration than women without depressive symptoms during the second trimester of pregnancy (β=0.21 weeks [95% confidence interval, -0.17 to 0.58; P=.28] during the first trimester of pregnancy; β=0.41 weeks [95% confidence interval, 0.10-0.71; P=.009] during the second trimester of pregnancy; β=0.17 weeks [95% confidence interval, -0.14 to 0.47; P=.29] during the third trimester of pregnancy). Sustained first- and second-trimester depressive symptoms were associated with 0.72 weeks higher placental age acceleration (95% confidence interval, 0.29-1.15; P=.001) than no depressive symptom in the 2 trimesters. The association between second-trimester depressive symptoms and higher placental epigenetic age acceleration strengthened in the analysis of pregnancies with male fetuses (β=0.53 weeks; 95% confidence interval, 0.06-1.08; P=.03) but was not significant in pregnancies with female fetuses. CONCLUSION Antenatal depressive symptoms during the second trimester of pregnancy were associated with an average of 0.41 weeks of increased placental age acceleration. Accelerated placental aging may play an important role in the underlying mechanism linking antenatal depression to pregnancy complications related to placental dysfunction.
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Affiliation(s)
- Haleema Saeed
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (Dr Saeed); Department of Maternal-Fetal Medicine, Medstar Washington Hospital Center, Washington, DC (Drs Saeed)
| | - Jing Wu
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (Drs Wu, Grantz, and Tekola-Ayele)
| | - Markos Tesfaye
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, University of Oslo, Oslo, Norway (Dr Tesfaye); Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Dr Tesfaye)
| | - Katherine L Grantz
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (Drs Wu, Grantz, and Tekola-Ayele)
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (Drs Wu, Grantz, and Tekola-Ayele).
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Liseth O, Weng J, Schenone M, Moore K, Betcher H, Branda M, Rivera-Chiauzzi E, Larish A. The impact of fetal surgical procedures on perinatal anxiety and depression. Am J Obstet Gynecol MFM 2024; 6:101244. [PMID: 38061550 DOI: 10.1016/j.ajogmf.2023.101244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Perinatal mental illness presents a significant health burden to both patients and families. Many factors are hypothesized to increase the incidence of perinatal depression and anxiety in the fetal surgical population, including uncertain fetal prognosis and inherent risks of surgery and preterm delivery. OBJECTIVE This study aimed to determine the incidence and disease course of postpartum depression and anxiety in the fetal surgery population. STUDY DESIGN A retrospective medical record review study was conducted of fetal surgery patients delivering between November 2016 and November 2021 at an academic level IV perinatal healthcare center. Demographics and surgical, obstetrical, and psychiatric diagnoses were abstracted. Standard descriptive analyses were performed. RESULTS Eligible patients were identified (N=119). Fetal surgery was performed at a mean gestational age of 22.8 weeks (standard deviation, 4.11). Laser ablation of placental anastomoses (n=51) and in utero myelomeningocele repair (n=22) were the most common procedures. Of 119 patients, 34 (28.6%) were diagnosed with preexisting depression or anxiety, with 19 (55.9%) and 17 (50.0%) on baseline medication for depression or anxiety, respectively, before surgery. Of 85 patients, 23 (27.1%) without a history of anxiety or depression had new identification of one or both after delivery. Of note, 2 patients experienced suicidal ideation after delivery. Of the 119 patients, 8 (6.7%) and 12 (10.1%) initiated a new psychiatric medication during or after pregnancy, respectively, and 19 (16.0%) received a therapy referral. Among patients with baseline anxiety or depression, 20 of 34 patients (58.8%) experienced an exacerbation after delivery, 9 of 34 patients (26.5%) were referred for therapy, 9 of 34 patients (26.5%) were changing dose or medication for anxiety, and 11 of 34 patients (32.4%) were changing dose or medication for depression. Of the 119 patients, 24 (20.2%) experienced new or worsening depression or anxiety after the standard 6-week postpartum visit. CONCLUSION Among patients undergoing fetal surgery, a high incidence of postpartum depression and anxiety was identified, with most patients with prepregnancy anxiety or depression experiencing exacerbation after delivery. The timeframe to clinical presentation with depression or anxiety symptoms may be delayed beyond the traditional 6-week postpartum period and into the first postpartum year. This observation could be attributed to de novo postpartum exacerbation or a lack of standardized treatment approaches earlier in the disease course or antepartum period. Understanding effective longitudinal supportive interventions is an essential next step.
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Affiliation(s)
- Olivia Liseth
- Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (Mses Liseth and Weng)
| | - Jessica Weng
- Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (Mses Liseth and Weng)
| | - Mauro Schenone
- Departments of Obstetrics and Gynecology (Drs Schenone, Rivera-Chiauzzi, and Larish)
| | | | | | - Megan Branda
- and Biostatistics (Ms Branda), Mayo Clinic, Rochester, MN
| | - Enid Rivera-Chiauzzi
- Departments of Obstetrics and Gynecology (Drs Schenone, Rivera-Chiauzzi, and Larish)
| | - Alyssa Larish
- Departments of Obstetrics and Gynecology (Drs Schenone, Rivera-Chiauzzi, and Larish).
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Pollack LM, Chen J, Cox S, Luo F, Robbins CL, Tevendale H, Li R, Ko JY. Rural/urban differences in health care utilization and costs by perinatal depression status among commercial enrollees. J Rural Health 2024; 40:26-63. [PMID: 37467110 PMCID: PMC10796846 DOI: 10.1111/jrh.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/09/2023] [Accepted: 06/13/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE To understand differences in health care utilization and medical expenditures by perinatal depression (PND) status during pregnancy and 1-year postpartum overall and by rural/urban status. METHODS We estimated differences in health care utilization and medical expenditures by PND status for individuals with an inpatient live-birth delivery in 2017, continuously enrolled in commercial insurance from 3 months before pregnancy through 1-year postpartum (study period), using MarketScan Commercial Claims data. Multivariable regression was used to examine differences by rurality. FINDINGS Ten percent of commercially insured individuals had claims with PND. A smaller proportion of rural (8.7%) versus urban residents (10.0%) had a depression diagnosis (p < 0.0001). Of those with PND, a smaller proportion of rural (5.5%) versus urban residents (9.6%) had a depression claim 3 months before pregnancy (p < 0.0001). Compared with urban residents, rural residents had greater differences by PND status in total inpatient days (rural: 0.7, 95% confidence interval [CI]: 0.6-0.9 vs. urban: 0.5, 95% CI: 0.5-0.6) and emergency department (ED) visits (rural: 0.7, 95% CI: 0.6-0.9 vs. urban: 0.5, 95% CI: 0.4-0.5), but a smaller difference by PND status in the number of outpatient visits (rural: 9.2, 95% CI: 8.2-10.2 vs. urban: 13.1, 95% CI: 12.7-13.5). Differences in expenditures for inpatient services by PND status differed by rural/urban status (rural: $2654; 95% CI: $1823-$3485 vs. urban: $1786; 95% CI: $1445-$2127). CONCLUSIONS Commercially insured rural residents had more utilization for inpatient and ED services and less utilization for outpatient services. Rural locations can present barriers to evidence-based care to address PND.
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Affiliation(s)
- Lisa M. Pollack
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jiajia Chen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheryl L. Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather Tevendale
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rui Li
- Division of Research, Office of Epidemiology and Research, Health Resources and Services Administration, Maternal and Child Health Bureau, US Department of Health and Human Services, Rockville, Maryland, USA
| | - Jean Y. Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Commissioned Corps, United States Public Health Service, United States Department of Health and Human Services, Rockville, Maryland, USA
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Ghahyazi K, Familiar-Lopez I, Culbert O, Uruchima J, Van Engen A, Cevallos W, Eisenberg JNS, Levy K, Lee GO. Correlates of maternal depression, anxiety and functioning across an urban-rural gradient in northern Ecuador. Glob Public Health 2024; 19:2291697. [PMID: 38084739 PMCID: PMC10787496 DOI: 10.1080/17441692.2023.2291697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023]
Abstract
Maternal depression remains under characterised in many low- and middle-income countries, especially in rural settings. We aimed to describe maternal depression and anxiety symptoms in rural and urban communities in northern Ecuador and to identify socioeconomic and demographic factors associated with these symptoms. Data from 508 mothers participating in a longitudinal cohort study were included. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist (HSCL-25), and maternal psychological functioning was assessed using a checklist of daily activities. Tobit regression models were used to examine associations with sociodemographic variables and urbanicity. The median HSCL-25 score was 1.2 (IQR: 0.4) and 14% of women scored above the threshold for clinically relevant symptoms. Rural women reported similar food insecurity, less education, younger age of first pregnancy, and lower socio-economic status compared to their urban counterparts. After adjusting for these factors, rural women reported lower HSCL-25 scores compared to women lin urban areas (β = -0.48, 95%CI:0.65, -0.31). Rural residence was also associated with lower depression and anxiety HSCL-25 sub-scale scores, and similar levels of maternal functioning, compared to urban residence. Our results suggest that both household and community-level factors are risk factors for maternal depression and anxiety in this context.
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Affiliation(s)
- Kiana Ghahyazi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Oriana Culbert
- Rutgers Global Health Institute and Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Jessica Uruchima
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Amanda Van Engen
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - William Cevallos
- Instituto de Biomedicina, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | - Joseph N S Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington, School of Public Health, Seattle, Washington, USA
| | - Gwenyth O Lee
- Rutgers Global Health Institute and Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey, USA
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Mhango W, Crowter L, Michelson D, Gaysina D. Psychoeducation as an active ingredient for interventions for perinatal depression and anxiety in youth: a mixed-method systematic literature review and lived experience synthesis. BJPsych Open 2023; 10:e10. [PMID: 38088162 PMCID: PMC10755556 DOI: 10.1192/bjo.2023.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2023] [Accepted: 10/14/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Psychoeducation is a common element in psychological interventions for youth depression and anxiety, but evidence about its use with youth perinatally is limited. AIMS This review aims to understand outcomes and mechanisms of psychoeducation for the indicated prevention and treatment of perinatal depression and anxiety in youth. METHOD For this review, we synthesised published quantitative and qualitative evidence. Seven databases (ASSIA, Medline, PubMed, PsycINFO, PsycArticles, Scopus and Web of Science) were searched for studies published before 10 August 2021. We also had consultations with a youth advisory group (N = 12). RESULTS In total, 20 studies met the inclusion criteria. Seven quantitative studies examined multicomponent interventions that included psychoeducation, and one study evaluated psychoeducation as a standalone intervention for postnatal depression. Multicomponent interventions showed significant effects on postnatal depression in two out of six studies, as well as being effective at reducing prenatal anxiety in one study. Standalone psychoeducation for postnatal depression was also effective in one study. Evidence from 12 qualitative studies, corroborated by commentaries from the youth advisory group, suggested that psychoeducation could increase knowledge about symptoms, generate awareness of relevant services and enhance coping. CONCLUSIONS Psychoeducation may be an important foundational ingredient of interventions for perinatal depression and, potentially, anxiety in adolescents and young adults through stimulating help-seeking and self-care.
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Affiliation(s)
- Wezi Mhango
- School of Psychology, University of Sussex, UK; and Department of Psychology, University of Malawi, Malawi
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Sultan P, Guo N, Kawai M, Barwick FH, Carvalho B, Mackey S, Kallen MA, Gould CE, Butwick AJ. Prevalence and predictors for postpartum sleep disorders: a nationwide analysis. J Matern Fetal Neonatal Med 2023; 36:2170749. [PMID: 36710393 DOI: 10.1080/14767058.2023.2170749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe the prevalence and predictors of postpartum sleep disorders. DESIGN A retrospective cohort study. SETTING Postpartum. POPULATION Commercially insured women delivering in California (USA) between 2011 and 2014. METHODS Using the Optum Clinformatics Datamart Database. MAIN OUTCOME MEASURES Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression. RESULTS We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92). CONCLUSIONS Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.
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Affiliation(s)
- P Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M Kawai
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - F H Barwick
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M A Kallen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - A J Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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23
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Bränn E, Vaina A, Daníelsdóttir HB, Thordardottir EB, Yang Q, Jakobsdóttir J, Aspelund T, Hauksdóttir A, Valdimarsdóttir UA, Lu D. Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland. Arch Womens Ment Health 2023; 26:839-849. [PMID: 37726573 PMCID: PMC10632282 DOI: 10.1007/s00737-023-01369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
Emerging data suggest that certain adverse childhood experiences (ACEs) are associated with perinatal depression (PND). However, few studies have comprehensively assessed the cumulative number and types of ACEs and their association to PND. We conducted a cross-sectional analysis among 16,831 female participants from the Stress-And-Gene-Analysis (SAGA) cohort in Iceland, 2018. ACEs were surveyed with the World Health Organization ACE-International questionnaire, while PND symptoms were assessed using the Edinburgh Postnatal Depression Scale (lifetime version). We, while adjusting for confounding factors, estimated the prevalence ratio (PR) of PND in relation to total number of ACEs using the Poisson quasi-likelihood model and further performed analyses for type-specific ACEs. At a mean age of 44 years (SD ± 11.1), 6,201 (36.8%) participants had experienced probable PND. Total number of ACEs was positively associated with PND (PR 1.11 per ACE, 95% CI: 1.10-1.11), also among women without any psychiatric comorbidities (PR 1.13, 95% CI: 1.11-1.14). PRs increased in a dose-response manner with the number of ACEs (P for trend < 0.001); women that endorsed 5 or more ACEs were twice as likely to have experienced PND (PR 2.24, 95% CI: 2.09-2.41). All ACE types (n = 13) were associated with PND, with most pronounced association for emotional neglect by a guardian (PR 1.53, 95% CI: 1.47-1.59). Our findings suggest a positive association between number of ACEs and PND symptoms. If our results are confirmed with prospective data, healthcare providers need to be alert of the risk of PND among expecting mothers with history of ACEs.
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Affiliation(s)
- Emma Bränn
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Alexandra Vaina
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Qian Yang
- Department of Medicine, Unit of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Unnur A Valdimarsdóttir
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Donghao Lu
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
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24
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Patra BG, Sun Z, Cheng Z, Kumar PKRJ, Altammami A, Liu Y, Joly R, Jedlicka C, Delgado D, Pathak J, Peng Y, Zhang Y. Automated classification of lay health articles using natural language processing: a case study on pregnancy health and postpartum depression. Front Psychiatry 2023; 14:1258887. [PMID: 38053538 PMCID: PMC10694448 DOI: 10.3389/fpsyt.2023.1258887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023] Open
Abstract
Objective Evidence suggests that high-quality health education and effective communication within the framework of social support hold significant potential in preventing postpartum depression. Yet, developing trustworthy and engaging health education and communication materials requires extensive expertise and substantial resources. In light of this, we propose an innovative approach that involves leveraging natural language processing (NLP) to classify publicly accessible lay articles based on their relevance and subject matter to pregnancy and mental health. Materials and methods We manually reviewed online lay articles from credible and medically validated sources to create a gold standard corpus. This manual review process categorized the articles based on their pertinence to pregnancy and related subtopics. To streamline and expand the classification procedure for relevance and topics, we employed advanced NLP models such as Random Forest, Bidirectional Encoder Representations from Transformers (BERT), and Generative Pre-trained Transformer model (gpt-3.5-turbo). Results The gold standard corpus included 392 pregnancy-related articles. Our manual review process categorized the reading materials according to lifestyle factors associated with postpartum depression: diet, exercise, mental health, and health literacy. A BERT-based model performed best (F1 = 0.974) in an end-to-end classification of relevance and topics. In a two-step approach, given articles already classified as pregnancy-related, gpt-3.5-turbo performed best (F1 = 0.972) in classifying the above topics. Discussion Utilizing NLP, we can guide patients to high-quality lay reading materials as cost-effective, readily available health education and communication sources. This approach allows us to scale the information delivery specifically to individuals, enhancing the relevance and impact of the materials provided.
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Affiliation(s)
- Braja Gopal Patra
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Zhaoyi Sun
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Zilin Cheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | | | - Abdullah Altammami
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Yiyang Liu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States
| | - Caroline Jedlicka
- Kingsborough Community College, City University of New York, New York, NY, United States
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, United States
| | - Diana Delgado
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, United States
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Yifan Peng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
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25
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Ciciolla L, Shreffler KM, Jones EJ. Mindfulness interventions during pregnancy reduce depressive symptoms among healthy pregnant women. Evid Based Nurs 2023:ebnurs-2023-103752. [PMID: 37949633 PMCID: PMC11188617 DOI: 10.1136/ebnurs-2023-103752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Lucia Ciciolla
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Karina M Shreffler
- Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Emily J Jones
- Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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26
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Zimmermann M, Peacock-Chambers E, Merton C, Pasciak K, Thompson A, Mackie T, Clare CA, Lemon SC, Byatt N. Equitable reach: Patient and professional recommendations for interventions to prevent perinatal depression and anxiety. Gen Hosp Psychiatry 2023; 85:95-103. [PMID: 37862962 PMCID: PMC11056209 DOI: 10.1016/j.genhosppsych.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Perinatal depression and anxiety are the most common complications in the perinatal period and disproportionately affect those experiencing economic marginalization. Fewer than 15% of individuals at risk for perinatal depression are referred for preventative counseling. The goal of this study was to elicit patient and perinatal care professionals' perspectives on how to increase the reach of interventions to prevent perinatal depression and anxiety among economically marginalized individuals. METHODS We conducted qualitative interviews with perinatal individuals with lived experience of perinatal depression and/or anxiety who were experiencing economic marginalization (n = 12) and perinatal care professionals and paraprofessionals (e.g., obstetrician/gynecologists, midwives, doulas; n = 12) serving this population. Three study team members engaged a "a coding consensus, co-occurrence, and comparison," approach to code interviews. RESULTS Perinatal individuals and professionals identified prevention intervention delivery approaches and content to facilitate equitable reach for individuals who are economically marginalized. Factors influential included availability of mental health counselors, facilitation of prevention interventions by a trusted professional, digital health options, and options for mental health intervention delivery approaches. Content that was perceived as increasing equitable intervention reach included emphasizing stigma reduction, using cultural humility and inclusive materials, and content personalization. CONCLUSIONS Leveraging varied options for mental health intervention delivery approaches and content could reach perinatal individuals experiencing economic marginalization and address resource considerations associated with preventative interventions.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America.
| | - Elizabeth Peacock-Chambers
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Catherine Merton
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Katarzyna Pasciak
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Azure Thompson
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Thomas Mackie
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Camille A Clare
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
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27
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Elhoff JJ, Kasparian NA. If Not Now, When? Taking Action to Improve Mental Health Outcomes for Families of Children With Heart Disease. Pediatr Crit Care Med 2023; 24:966-969. [PMID: 37916879 DOI: 10.1097/pcc.0000000000003319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Justin J Elhoff
- Department of Pediatrics, Pediatrix Medical Group/Sunrise Children's Hospital and Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV
| | - Nadine A Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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28
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Ciolac L, Craina ML, Enatescu VR, Tudor A, Bernad ES, Nitu R, Hogea L, Boscu L, Bernad BC, Timircan MO, Ciolac V, Nediglea CO, Maghiari AL. The Impact of the COVID-19 Pandemic on Depressive Disorder with Postpartum Onset: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2857. [PMID: 37958002 PMCID: PMC10648077 DOI: 10.3390/healthcare11212857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND COVID-19 has led to a global health crisis that is defining for our times and one of the greatest challenges to emerge since World War II. The potential impact of the pandemic on mental health should not be overlooked, especially among vulnerable populations such as women who gave birth during the COVID-19 pandemic. MATERIALS AND METHODS The study is a cross-sectional survey conducted from 1 March 2020 to 1 March 2023, during the period of the SARS-CoV-2 (COVID-19) pandemic, based on a retrospective evaluation of 860 postpartum women. The screening tool used to assess symptoms of postpartum depression was the Edinburgh Postnatal Depression Rating Scale (EPDS) questionnaire. The questionnaire was completed both in the Obstetrics and Gynaecology Clinical Sections I and II of the "Pius Brînzeu" County Emergency Hospital in Timisoara, Romania, and online using Google Forms. RESULTS The highest severity of postpartum depression symptoms was observed during the COVID-19 pandemic. The results of the study conducted during the period of the SARS-CoV-2 pandemic (COVID-19) showed that the prevalence of major postpartum depressive disorder (EPDS ≥ 13) was 54.2% (466 patients), while 15.6% (134) had minor depressive disorder (10 < EPDS ≤ 12) in the first year after delivery. Comparing these results with those obtained in research conducted before the onset of the pandemic period showed an alarming increase in the prevalence of postpartum depression. The risk factors associated with postpartum depression included the type of delivery, level of education, socio-economic conditions, health status, age, background, and personal obstetric history (number of abortions on demand, parity). CONCLUSIONS The effects of the pandemic on mental health are of particular concern for women in the first year after childbirth. Observing these challenges and developing effective measures to prepare our health system early can be of great help for similar situations in the future. This will help and facilitate effective mental health screening for postpartum women, promoting maternal and child health.
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Affiliation(s)
- Livia Ciolac
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Doctoral School, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Marius Lucian Craina
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Virgil Radu Enatescu
- Psychiatric Clinic, “Pius Brinzeu” Emergency County Hospital, 156 Liviu Rebreanu Blvd., 300723 Timisoara, Romania;
- Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
| | - Anca Tudor
- Discipline of Computer Science and Medical Biostatistics, University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania
| | - Elena Silvia Bernad
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Razvan Nitu
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Lavinia Hogea
- Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Center for Neuropsychology and Behavioral Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Lioara Boscu
- Doctoral School, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Senate Office, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Brenda-Cristiana Bernad
- Doctoral School, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Center for Neuropsychology and Behavioral Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Madalina Otilia Timircan
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Valeria Ciolac
- Department of Sustainable Development and Environmental Engineering, University of Life Sciences “King Michael I”, 300645 Timisoara, Romania;
| | - Cristian-Octavian Nediglea
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 325100 Timisoara, Romania;
| | - Anca Laura Maghiari
- Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
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Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. OBJECTIVES To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. DATA COLLECTION AND ANALYSIS Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. MAIN RESULTS Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). AUTHORS' CONCLUSIONS The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Jd Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Canfield SM, Canada KE, Rolbiecki AJ, Petroski GF. Feasibility and acceptability of an online mental health intervention for pregnant women and their partners: a mixed method study with a pilot randomized control trial. BMC Pregnancy Childbirth 2023; 23:739. [PMID: 37853333 PMCID: PMC10585730 DOI: 10.1186/s12884-023-06031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Untreated perinatal mood and anxiety disorders (PMAD) have short- and long-term health and social consequences; online cognitive behavioral therapy (CBT) interventions can reduce symptoms. Despite partner support being protective online interventions rarely target couples. This study builds on research on an existing CBT-based intervention, the Mothers and Babies Online Course (eMB), by testing its feasibility with prenatal couples. METHODS We conducted a pilot, randomized, controlled feasibility trial using a 1:1 parallel design. To be eligible, participant dyads were pregnant people (between 13-30 weeks gestation and with a score of 10 or greater on either the GAD-7 or PHQ-9 scale indicating elevated symptoms of anxiety or depression) and their cohabitating partners, living in Missouri, with access to the internet; both in the dyad consented to participate. Recruitment occurred via Facebook ads, flyers, and a snowball approach. The intervention group received eMB, and the control group received a list of community resources. We examined retention and adherence data extracted from eMB analytics and study databases. All participants were given depression and anxiety scales at baseline, 4 and 8 weeks to test preliminary efficacy; satisfaction and acceptability were measured at trial end (i.e., eight weeks) and via interview. RESULTS There were 441 people who responded to recruitment materials, 74 pregnant people were screened; 19 partners did not complete enrolment, and 25 dyads were ineligible. There were 15 dyads per group (N = 30) who enrolled; all completed the study. The survey response rate was 90% but partners required nearly twice the number of reminders. No participant completed all lessons. Mean depression and anxiety scores dropped over time for dyads in control (M = -1.99, -1.53) and intervention (M = -4.80, -1.99). Intervention pregnant people's anxiety significantly decreased (M = -4.05; 95% CI [0.82, 7.27]) at time two compared to control. Twelve pregnant people and four partners participated in post-intervention interviews and suggested improvements for eMB. CONCLUSION Online dyadic interventions can potentially reduce PMAD symptoms. However, to feasibly study eMB with couples, strategies to increase program adherence are necessary. Tailoring interventions to overtly include partners may be advantageous. TRIAL REGISTRATION ClinicalTrials.gov NCT05867680, 19/05/2023.
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Affiliation(s)
- Shannon M Canfield
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA.
| | - Kelli E Canada
- School of Social Work, University of Missouri, Columbia, MO, USA
| | - Abigail J Rolbiecki
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
- Department of Family Medicine and Division of Geriatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory F Petroski
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
- Department of Biomedical Informatics, Biostatistics, and Medical Epidemiology, School of Medicine - University of Missouri, Columbia, MO, USA
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Lin Y, Zhang X, Zhou T, Xu F, Zhu X, Zhou H, Wang X, Ding Y. Identifying the common elements of psychological and psychosocial interventions for preventing postpartum depression: Application of the distillation and matching model to 37 winning protocols from 36 intervention studies. Early Interv Psychiatry 2023; 17:947-962. [PMID: 37680169 DOI: 10.1111/eip.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/16/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
AIM Postpartum depression is prevalent worldwide and seriously endangers maternal and child health. Previous studies have demonstrated the effectiveness of psychological and psychosocial intervention programmes in preventing postpartum depression. However, the literature offers limited practice guidance. Therefore, this study aimed to deeply analyse prior findings to gather rich evidence-based information on this topic. METHODS Using the distillation and matching model, we conducted a systematic review of psychological and psychosocial interventions used to effectively prevent postpartum depression. Four researchers trained in coding system independently read eligible studies and identified reliable (Cohen's kappa >0.40) and frequently occurring (frequency ≥3 winning study groups) practice elements. RESULTS Our review included 36 studies containing 37 winning study groups. Fourteen practice elements were identified and subsequently divided into six categories: postpartum practical problems-related, social support-related, interpersonal psychotherapy-related, cognitive behavioural therapy-related, labour trauma-related and non-specific techniques. The most common practice elements were baby care skills and mother-infant bonding/interaction enhancement. Inter-rater reliability averaged 0.86, ranging from 0.48 to 1. CONCLUSION The practice elements identified in this study provide rich evidence-based information that can guide clinical practitioners in selecting or developing effective, realistically available intervention programmes.
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Affiliation(s)
- Yuping Lin
- School of Nursing, Fudan University, Shanghai, China
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | | | - Tianchun Zhou
- School of Nursing, Fudan University, Shanghai, China
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Feng Xu
- Nursing Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xinli Zhu
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Huixin Zhou
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xiao Wang
- Department of Obstetrics, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
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Weissman MM. Does treatment-resistant depression need psychotherapy? World Psychiatry 2023; 22:417-418. [PMID: 37713551 PMCID: PMC10503899 DOI: 10.1002/wps.21137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 09/17/2023] Open
Affiliation(s)
- Myrna M Weissman
- Columbia University Vagelos College of Physicians and Surgeons, Mailman School of Public Health; Division of Translational Epidemiology and Mental Health Equity, New York State Psychiatric Institute, New York, NY, USA
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Stefana A, Langfus JA, Palumbo G, Cena L, Trainini A, Gigantesco A, Mirabella F. Comparing the factor structures and reliabilities of the EPDS and the PHQ-9 for screening antepartum and postpartum depression: a multigroup confirmatory factor analysis. Arch Womens Ment Health 2023; 26:659-668. [PMID: 37464191 PMCID: PMC10491522 DOI: 10.1007/s00737-023-01337-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 07/20/2023]
Abstract
To evaluate and compare the factor structure and reliability of EPDS and PHQ in antepartum and postpartum samples. Parallel analysis and exploratory factor analysis were conducted to determine the structure of both scales in the entire sample as well as in the antepartum and postpartum groups. McDonald's omega statistics examined the utility of treating items as a single scale versus multiple factors. Multigroup confirmatory factor analysis (MCFA) was utilized to test the measurement invariance between the antepartum and postpartum groups. Two-factor models fit best for the EPDS in both the antepartum and postpartum groups; however, the most reliable score variance was attributable to a general factor for each scale. MCFA provided evidence of weak invariance across groups regarding factor loadings and partial invariance regarding item thresholds. PHQ-9 showed a two-factor model in the antepartum group; however, the same model did not fit well in the postpartum group. EPDS should be preferred to PHQ-9 for measuring depressive symptoms in peripartum populations. Both scales should be used as a single-factor scale. Caution is required when comparing the antepartum and postpartum scores.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Joshua A Langfus
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Gabriella Palumbo
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Rome, Italy
| | - Loredana Cena
- Department of Clinical and Experimental Sciences, Section of Neuroscience, Observatory of Perinatal Clinical Psychology, University of Brescia, Brescia, Italy
| | - Alice Trainini
- Department of Clinical and Experimental Sciences, Section of Neuroscience, Observatory of Perinatal Clinical Psychology, University of Brescia, Brescia, Italy
| | - Antonella Gigantesco
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Rome, Italy
| | - Fiorino Mirabella
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Rome, Italy
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Rodriguez-Muñoz MF, Kovacheva K, García-López HS, Le HN, Ruiz N, Olivares ME, Izquierdo Mendez N, Coronado P. The healthy moms and babies app to prevent postpartum depression: analysis of user-profiles and dropout cases. Front Public Health 2023; 11:1186963. [PMID: 37786785 PMCID: PMC10541948 DOI: 10.3389/fpubh.2023.1186963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/03/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction Perinatal depression affects mothers, babies and society. Preventive interventions are needed, but face barriers to access. E-health interventions could be an effective and accessible option. To date, few studies have attempted to understand the use of mobile health (m-health) applications and why they are not more widely used. This study aims to understand the demographic characteristics of enrolled participants and examine dropout patterns through the Healthy Moms and Babies app. Methods A longitudinal study was conducted with a sample of 511 women recruited between 2020 and 2022. Data were collected from the app, including sociodemographic information, the participant's progress through the modules of the app, and the permissions granted to use the app. Results Out of the 511 women who completed the initial form to initiate participation, 279 downloaded the app and completed the evaluation. Results indicated that granting permission to be notified about the module's availability is related to an increase in the use of the first modules. Conclusion This study shows the importance of establishing follow-ups in the use of mobile apps during the perinatal period.
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Affiliation(s)
| | - Katina Kovacheva
- School of Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Helena S. García-López
- Psychology and Social Sciences, University of Maryland Global Campus (Europe Site), Adelphi, MD, United States
| | - Huynh-Nhu Le
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, United States
| | - Natalia Ruiz
- School of Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Maria Eugenia Olivares
- Faculty of Medicine, Department of Gynecology and Obstetrics, Instituto de Salud de la Mujer José Botella Llusiá, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria Izquierdo Mendez
- Faculty of Medicine, Department of Gynecology and Obstetrics, Instituto de Salud de la Mujer José Botella Llusiá, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Pluvio Coronado
- Faculty of Medicine, Department of Gynecology and Obstetrics, Instituto de Salud de la Mujer José Botella Llusiá, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
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Waqas A, Nadeem M, Rahman A. Exploring Heterogeneity in perinatal depression: a comprehensive review. BMC Psychiatry 2023; 23:643. [PMID: 37667216 PMCID: PMC10478465 DOI: 10.1186/s12888-023-05121-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
Perinatal depression (PND) is a significant contributor to maternal morbidity globally. Recognized as a major cause of poor infant development, epidemiological and interventional research on it has increased over the last decade. Recently, studies have pointed out that PND is a heterogeneous condition, with variability in its phenotypes, rather than a homogenous latent entity and a concrete diagnosis, as previously conceptualized in psychometric literature and diagnostic systems. Therefore, it is pertinent that researchers recognize this to progress in elucidating its aetiology and developing efficacious interventions.This systematic review is conducted in accordance with the Meta-analysis of observational studies in epidemiology (MOOSE). It aims to provide an updated and comprehensive account of research on heterogeneity in phenotypes of PND and its implications in research, public health, and clinical practice. It provides a synthesis and quality assessment of studies reporting heterogeneity in PND using cutting-edge statistical techniques and machine learning algorithms. After reporting the phenotypes of PND, based on heterogeneous trajectories and symptom profiles, it also elucidates the risk factors associated with severe forms of PND, followed by robust evidence for adverse child outcomes. Furthermore, recommendations are made to improve public health and clinical practice in screening, diagnosis, and treatment of PND.
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Affiliation(s)
- Ahmed Waqas
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK.
| | | | - Atif Rahman
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Johnson JE, Loree AM, Sikorskii A, Miller TR, Carravallah L, Taylor B, Zlotnick C. Study protocol for the ROSE Scale-Up Study: Informing a decision about ROSE as universal postpartum depression prevention. Contemp Clin Trials 2023; 132:107297. [PMID: 37473848 PMCID: PMC10528027 DOI: 10.1016/j.cct.2023.107297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To examine the effectiveness, cost-outcome, equity, scalability, and mechanisms of the Reach Out, Stay strong, Essentials for mothers of newborns (ROSE) postpartum depression prevention (PPD) program as universal versus selective or indicated prevention. BACKGROUND The United States Preventive Services Task Force (USPSTF) currently recommends PPD prevention for pregnant people at risk of PPD (i.e., selective/indicated prevention). However, universal prevention may be more scalable, equitable, and cost-beneficial. DESIGN Effectiveness of ROSE for preventing PPD among people at risk is known. To assess ROSE as universal prevention, we need to determine the effectiveness of ROSE among all pregnant people, including those screening negative for PPD risk. We will enroll 2320 pregnant people, assess them with commonly available PPD risk prediction tools, randomize everyone to ROSE or enhanced care as usual, and assess ROSE as universal, selective, and indicated prevention in terms of: (1) effectiveness (PPD prevention and functioning), (2) cost-benefit, (3) equity (PPD cases prevented by universal prevention that would not be prevented under selective/indicated for minority vs. non-Hispanic white people), (4) quantitative and qualitative measures of scalability (from 98 agencies previously implementing ROSE), (5) ROSE mechanisms across risk levels. We will integrate results to outline pros and cons of the three prevention approaches (i.e., universal, selective, indicated). CONCLUSION This will be the first trial to assess universal vs. selective/indicated PPD prevention. Trial design illustrates a novel, efficient way to make these comparisons. This trial, the largest PPD prevention trial to date, will examine scalability, an understudied area of implementation science.
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Affiliation(s)
- Jennifer E Johnson
- Charles Stewart Mott Department of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 366, Flint, MI 48502, United States of America.
| | - Amy M Loree
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, Suite 5E, Detroit, MI 48220, United States of America.
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University College of Osteopathic Medicine, 909 Wilson Rd, East Lansing, MI 48824, United States of America.
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive Suite 900, Calverton, MD 20705, United States of America.
| | - Laura Carravallah
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, 200 East 1(st) St, Flint, MI 48502, United States of America.
| | - Brandon Taylor
- Charles Stewart Mott Department of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 366, Flint, MI 48502, United States of America.
| | - Caron Zlotnick
- Butler Hospital and Women and Infants Hospital, 345 Blackstone Blvd, Providence, RI 02906, United States of America; University of Cape Town, Cape Town, South Africa.
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Ahmed SR, Watt F, Mahfoud ZR, Korayem M, Buhmaid S, Alberry M, Ibrahim IM, Tandon SD. Examining Feasibility, Acceptability, and Preliminary Outcomes of a Culturally Adapted Evidence-Based Postpartum Depression Preventive Intervention for Women in Doha, Qatar: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e11623. [PMID: 37566449 PMCID: PMC10457694 DOI: 10.2196/11623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Postpartum depression and anxiety are the 2 most common perinatal mental health disorders, with prevalence rates higher among women living in the Middle East than in most Western countries. The negative outcomes associated with postpartum depression and anxiety are profound and include less responsive parenting and compromised infant and young child development. Although interventions exist to prevent postpartum depression and anxiety, to date, there have been no studies that have attempted to prevent postpartum depression or anxiety among Arabic-speaking women in the Middle East, including Qatar. OBJECTIVE The purpose of this study is to conduct a randomized controlled trial (RCT) of an evidence-based postpartum depression preventive intervention-Mothers and Babies (MB)-culturally adapted for use with Arabic-speaking women in Doha, Qatar. MB is guided by a cognitive behavioral therapy framework that focuses on increasing pleasant activities, promoting healthy thought patterns, and increasing the type and frequency of personal contacts. MB is tailored to specific needs and issues related to pregnancy and the postpartum period. METHODS A multidisciplinary and multiethnic investigator team adapted MB to promote cultural and contextual fit for Arabic-speaking women. Intervention concepts were reviewed to ensure core content would be understood by Arabic-speaking women in Qatar. Subsequently, images, activities, and examples in the intervention manuals were adapted, as needed, to make the content more relevant to Arab culture. To deliver the adapted intervention, 30 Arabic-speaking individuals with mental health backgrounds were trained. The adapted intervention was subsequently pilot-tested with 10 pregnant women receiving prenatal care at Sidra Hospital in Doha. We are now conducting an RCT to examine the effectiveness of the adapted intervention. We plan to enroll 210 pregnant individuals who are Arabic-speaking, with 1:1 randomization to the MB intervention or usual prenatal care. Among the enrolled participants, a stratified subsample of 40 pregnant women with diabetes is being recruited. Data collection will take place at baseline and a 6-month follow-up. The primary outcomes are depressive and anxiety symptoms and perceived stress. Diabetes self-care is the exploratory outcome for the subsample of individuals with diabetes. Intervention implementation will be assessed via client and provider surveys during and after intervention delivery. Power and sample size were calculated using a 2-sided 5% effort rate and assumed analyses on the individual level, accounting for attrition of 20%. RESULTS The cultural adaptation and pilot study of the adapted MB intervention are completed. A total of 157 women have been enrolled in the RCT as of March 31, 2023. CONCLUSIONS This study is highly innovative, as it is the first study to our knowledge to examine the effectiveness of an evidence-based postpartum depression preventive intervention in the Middle East. Limitations include a single follow-up time point and a small subsample of individuals with diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT04442529; https://www.clinicaltrials.gov/study/NCT04442529. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/11623.
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Affiliation(s)
- Sawssan R Ahmed
- Department of Psychology, California State University-Fullerton, Fullerton, CA, United States
| | | | | | | | | | | | | | - S Darius Tandon
- Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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McLeish J, Ayers S, McCourt C. Community-based perinatal mental health peer support: a realist review. BMC Pregnancy Childbirth 2023; 23:570. [PMID: 37558998 PMCID: PMC10410814 DOI: 10.1186/s12884-023-05843-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/11/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Peer support has been suggested as an alternative or complement to professional support for mothers with perinatal mental health difficulties. The aim of this realist review was to synthesise the evidence on perinatal mental health peer support programmes outside mental health services, to understand what is it about community-based perinatal mental health peer support that works, for whom, in what circumstances, in what respects, and why. METHODS Applying realist methodology, an initial theoretical model was tested against evidence from empirical studies. 29 empirical studies were included, covering 22 antenatal and postnatal mental health interventions that offered one-to-one or group peer support, in person or by telephone. Data extraction identified the configurations of contexts (C), mechanisms (M) and outcomes (O) relevant to mothers' use of peer support and to the positive and negative effects of using peer support. RESULTS 13 C-M-O configurations explained take-up of peer support. These were based on mothers' perceptions that peer support would offer empathetic understanding and non-judgemental acceptance outside their social circle; their relationships with primary health professionals; their cultural background and perspectives on mental health; their desire for professional support; overcoming practical barriers; the format of the support; and the use of volunteers. A further 13 C-M-O configurations explained positive impact on mothers. These were based on receiving empathetic listening, acceptance, affirmation and normalisation; peers sharing ideas about self-care, coping, and services; peers using therapeutic techniques; the opportunity to give support to others; meaningful social relationships with volunteers and other mothers; and other benefits of attending a group. There were 8 C-M-O configurations explaining negative impact. These were based on lack of validation; self-criticism from downward and upward social comparison; a culture of negativity; peers being judgemental or directive; not feeling heard; peer support as a stressful social relationship; and distress at endings. CONCLUSIONS Peer support works in complex ways that are affected by personal and social contexts. Providers, commissioners and evaluators can use this review to understand and maximise the valuable benefits of peer support, to minimise potential risks, and to devise ways of reaching mothers who do not currently engage with it.
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Affiliation(s)
- Jenny McLeish
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, 1 Myddelton Street, London, EC1R 1UW, UK.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, 1 Myddelton Street, London, EC1R 1UW, UK
| | - Christine McCourt
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, 1 Myddelton Street, London, EC1R 1UW, UK
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Leng QL, Lo JO, Rakshe S, Hildebrand AD, Doyle OJ, Seghete KM, Graham A. The association between preconception cannabis use and depression and anxiety during pregnancy. Gen Hosp Psychiatry 2023; 83:148-155. [PMID: 37196406 PMCID: PMC10428863 DOI: 10.1016/j.genhosppsych.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Cannabis use among individuals of reproductive age has increased with cannabis legalization and heightened stress during the COVID-19 pandemic. Our study provides data on preconception cannabis use and cannabis use disorder (CUD) during the pandemic and models the association between preconception cannabis use and depression and anxiety during pregnancy. METHODS Data on substance use and depression and anxiety symptoms were collected from questionnaires and the Structured Clinical Interview for DSM-5 (SCID-5) from pregnant individuals in Oregon in 2019-2022. Linear regression was used to model the association between the frequency of preconception cannabis use and scores on the Center for Epidemiological Studies of Depression-Revised (CESD-R) and Beck Anxiety Inventory (BAI). RESULTS The prevalence of preconception cannabis use was 27.8% among 227 study participants. CUD was diagnosed in 19% of cannabis users, or 5.3% of the overall sample. Daily cannabis use, compared to rare/never use, was associated with increases in CESD-R (β = 6.22, p 0.029) and BAI (β = 4.71, p 0.045) scores. CONCLUSIONS Cannabis use and CUD are common among individuals of reproductive age. Given the association between preconception cannabis use and depression and anxiety during pregnancy, more attention is needed on screening and counseling of cannabis use among people of reproductive age.
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Affiliation(s)
- Qian Liya Leng
- Center for Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA.
| | - Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University; Portland, OR, USA
| | - Shauna Rakshe
- Knight Cancer Institute Biostatistics Shared Resource and OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Andrea D Hildebrand
- Biostatistics & Design Program, OHSU/PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Olivia J Doyle
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | | | - Alice Graham
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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Scandurra C, Mezzalira S, Aviani S, Lastra V, Bochicchio V, Zapparella R, Saccone G, Maldonato NM, Locci M. Perinatal depression during the fourth wave of the COVID-19 outbreak in a single prenatal clinic in Southern Italy: The role of loneliness, anxiety, and maternal support. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 13:100585. [PMID: 37152681 PMCID: PMC10141786 DOI: 10.1016/j.jadr.2023.100585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/15/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023] Open
Abstract
Background The current study aimed at assessing the levels of perinatal depression (i.e., both antenatal and postnatal) during the fourth wave of the COVID-19 outbreak in a group of Italian women, as well as to evaluate the role of loneliness, anxiety, and lack of maternal support in cumulatively predicting perinatal depression. Methods A cross-sectional study was conducted with 200 Italian women recruited during a peak of the COVID-19 pandemic in Italy (i.e., from September to December 2021) from a single prenatal clinic in Southern Italy. A non-parametric binomial test was conducted to assess whether the perinatal depression frequencies of the current sample differed from those found in a pre-Covid reference group. Additionally, hierarchical multiple linear regression analyses assessing whether loneliness, anxiety, and maternal support affected women's perinatal depression were also conducted. Results The general prevalence of perinatal depression was significantly higher in participants recruited during the fourth wave of the COVID-19 pandemic compared to the pre-Covid reference group (29% vs. 9.2%). However, results showed that, contrary to postnatal depression (18.2% vs. 19.9%), only the prevalence of antenatal depression was significantly higher compared to the pre-Covid reference group (39.6% vs. 6.4%). Furthermore, loneliness and anxiety, but not maternal support, were associated with higher levels of PD. Limitations Limitations concerned the cross-sectional nature of the study and the relatively small sample size. Conclusions This study sheds light on the need to address perinatal mental health of women during major stressful events, such as the COVID-19 pandemic.
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Affiliation(s)
- Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy
| | - Selene Mezzalira
- Department of Humanistic Studies, University of Calabria, Via Ponte Bucci Cubo 18/C, Rende 87036, Italy
| | - Silvia Aviani
- Intradepartmental Program of Clinical Psychology, Federico II University Hospital, Via Sergio Pansini 5, Napoli 80133, Italy
| | - Valeria Lastra
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy
| | - Vincenzo Bochicchio
- Department of Humanistic Studies, University of Calabria, Via Ponte Bucci Cubo 18/C, Rende 87036, Italy
| | - Rosanna Zapparella
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy
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Segre G, Clavenna A, Cartabia M, Bonati M. Postpartum depression screening in mothers and fathers at well-child visits: a feasibility study within the NASCITA cohort. BMJ Open 2023; 13:e069797. [PMID: 37355274 PMCID: PMC10314581 DOI: 10.1136/bmjopen-2022-069797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE To assess the feasibility of the family paediatrician's (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being. DESIGN, SETTING AND PARTICIPANTS Data for this observational prospective study were collected within the NASCITA (NAscere e creSCere in ITAlia) cohort. During the first visit, paediatricians collected sociodemographic data regarding the parents and information about their health status, the pregnancy and the delivery. Whooley questions were administered during the first and second visits (scheduled 60-90 days after childbirth). Moreover, on the third visit (5-7 months after childbirth) the FP was asked to answer 'yes' or 'no' to a question on the parental postpartum depression, based on his knowledge and on the acquired information. RESULTS In 2203 couples who completed the assessment, 529 mothers (19.9%), 141 fathers (6.3%) and 110 (5%) couples reported any depressive symptomatology. Of these, 141 mothers (5.3% of the total sample) and 18 fathers (0.8% of the total sample) were classified as 'likely depressed'. An association was found between maternal postnatal depressive symptoms and having a diagnosed psychiatric disorder during pregnancy (OR 9.49, 95% CI: 3.20 to 28.17), not exclusively breastfeeding at hospital discharge (OR 1.76, 95% CI: 1.19 to 2.61) and the presence of child sleeping disorders at 3 (OR 2.46, 95% CI: 1.41 to 4.28) and 6 months (OR 2.18, 95% CI: 1.37 to 3.47). Another significant predictor of postpartum depression was being primiparous (OR 1.99, 95% CI: 1.31 to 3.02). Concerning the fathers, a significant association was reported only between likely depressed fathers and child sleeping disorders at 3 months (OR 7.64, 95% CI: 2.92 to 19.97). Moreover, having a likely depressed partner was strongly associated with depressive symptoms in fathers (OR 85.53, 95% CI 26.83 to 272.69). CONCLUSIONS The findings of this study support the feasibility of an active screening programme for parental postnatal depression during well-child visits as an integral part of postpartum care. TRIAL REGISTRATION NUMBER NCT03894566; Pre-results.
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Affiliation(s)
- Giulia Segre
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Massimo Cartabia
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Bliddal M, Wesselhoeft R, Strandberg-Larsen K, Ernst MT, Weissman MM, Gingrich JA, Talati A, Pottegård A. Prenatal antidepressant exposure and emotional disorders until age 22: a danish register study. Child Adolesc Psychiatry Ment Health 2023; 17:73. [PMID: 37328889 DOI: 10.1186/s13034-023-00624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants in pregnancy. Animal and some clinical studies have suggested potential increases in depression and anxiety following prenatal SSRI exposure, but the extent to which these are driven by the medication remains unclear. We used Danish population data to test associations between maternal SSRI use during pregnancy and children outcomes up to age 22. METHODS We prospectively followed 1,094,202 single-birth Danish children born 1997-2015. The primary exposure was ≥ 1 SSRI prescription filled during pregnancy; the primary outcome, first diagnosis of a depressive, anxiety, or adjustment disorder, or redeemed prescription for an antidepressant medication. We used propensity score weights to adjust potential confounders, and incorporated data from the Danish National Birth Cohort (1997-2003) to further quantify potential residual confounding by subclinical factors. RESULTS The final dataset included 15,651 exposed and 896,818 unexposed, children. After adjustments, SSRI-exposed had higher rates of the primary outcome than those of mothers who either did not use an SSRI (HR = 1.55 [95%CI:1.44,1.67] or discontinued the SSRI use ≥ 3 months prior to conception (HR = 1.23 [1.13,1.34]). Age of onset was earlier among exposed (9 [IQR:7-13] years) versus unexposed (12 [IQR:12-17] years) children (p < 0.01). Paternal SSRI use in the absence of maternal use during the index pregnancy (HR = 1.46 [1.35,1.58]) and maternal SSRI use only after pregnancy (HR = 1.42 [1.35,1.49]) were each also associated with these outcomes. CONCLUSIONS While SSRI exposure was associated with increased risk in the children, this risk may be driven at least partly by underlying severity of maternal illness or other confounding factors.
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Affiliation(s)
- Mette Bliddal
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Rikke Wesselhoeft
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Department of Child and Adolescent Psychiatry, Odense Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | | | - Martin T Ernst
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Myrna M Weissman
- Department of Psychiatry, Columbia University Irving Medical Center and Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jay A Gingrich
- Department of Psychiatry, Columbia University Irving Medical Center and Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Ardesheer Talati
- Department of Psychiatry, Columbia University Irving Medical Center and Vagelos College of Physicians and Surgeons, New York, NY, USA.
- New York State Psychiatric Institute, New York, NY, USA.
- Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, Suite 6402B / Unit 24, New York, NY, 10032, USA.
| | - Anton Pottegård
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4. Obstet Gynecol 2023; 141:1232-1261. [PMID: 37486660 DOI: 10.1097/aog.0000000000005200] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
PURPOSE To review evidence on the current understanding of mental health conditions in pregnancy and postpartum, with a focus on mood and anxiety disorders, and to outline guidelines for screening and diagnosis that are consistent with best available scientific evidence. The conditions or symptoms reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, suicidality, and postpartum psychosis. For information on psychopharmacologic treatment and management, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 5, "Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum" (1). TARGET POPULATION Pregnant or postpartum individuals with mental health conditions. Onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal-fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on the screening and diagnosis of perinatal mental health conditions including depression, anxiety, bipolar disorder, acute postpartum psychosis, and the symptom of suicidality. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Johnson S, Kasparian NA, Cullum AS, Flanagan T, Ponting C, Kowalewski L, Main EK. Addressing Adverse Childhood and Adult Experiences During Prenatal Care. Obstet Gynecol 2023:00006250-990000000-00759. [PMID: 37141600 PMCID: PMC10184824 DOI: 10.1097/aog.0000000000005199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/08/2022] [Indexed: 05/06/2023]
Abstract
Adverse childhood and adult experiences can affect health outcomes throughout life and across generations. The perinatal period offers a critical opportunity for obstetric clinicians to partner with patients to provide support and improve outcomes. This article draws on stakeholder input, expert opinion, and available evidence to provide recommendations for obstetric clinicians' inquiry about and response to pregnant patients' past and present adversity and trauma during prenatal care encounters. Trauma-informed care is a universal intervention that can proactively address adversity and trauma and support healing, even if a patient does not explicitly disclose past or present adversity. Inquiry about past and present adversity and trauma provides an avenue to offer support and to create individualized care plans. Preparatory steps to adopting a trauma-informed approach to prenatal care include initiating education and training for practice staff, prioritizing addressing racism and health disparities, and establishing patient safety and trust. Inquiry about adversity and trauma, as well as resilience factors, can be implemented gradually over time through open-ended questions, structured survey measures, or a combination of both techniques. A range of evidence-based educational resources, prevention and intervention programs, and community-based initiatives can be included within individualized care plans to improve perinatal health outcomes. These practices will be further developed and improved by increased clinical training and research, as well as through broad adoption of a trauma-informed approach and collaboration across specialty areas.
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Affiliation(s)
- Sara Johnson
- La Clinica de La Raza, Oakland, the California Maternal Quality Care Collaborative and the Departments of Pediatrics and Obstetrics and Gynecology, School of Medicine, Stanford University, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California; and the Department of Pediatrics, University of Cincinnati College of Medicine, Center for Heart Disease and Mental Health, Heart Institute, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Liu H, Dai A, Zhou Z, Xu X, Gao K, Li Q, Xu S, Feng Y, Chen C, Ge C, Lu Y, Zou J, Wang S. An optimization for postpartum depression risk assessment and preventive intervention strategy based machine learning approaches. J Affect Disord 2023; 328:163-174. [PMID: 36758872 DOI: 10.1016/j.jad.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is one of the most common psychiatric disorders for women after delivery. The establishment of an effective PPD prediction model helps to distinguish high-risk groups, and verifying whether such high-risk groups can benefit from drug intervention is very important for clinical guidance. METHODS We collected data of parturients that underwent a cesarean delivery. The Control group was divided into a training cohort and a testing cohort. Six different ML models were constructed and we compared their prediction performance in the testing cohort. For model interpretation, we introduced SHapley Additive exPlanations (SHAP). Then, training cohort, ketamine group and dexmedetomidine (DEX) group were classified as high or low risk for PPD by the model. A 1:1 propensity score matching (PSM) was performed to compare the incidence of PPD between two groups in different risk cohorts. RESULTS Extreme gradient enhancement (XGB) had the best recognition effect, with an area under the receiver operating characteristic curve (AUROC) of 0.789 (95 % CI 0.742-0.836) in the training cohort and 0.744 (95 % CI 0.655-0.823) in the testing cohort, respectively. A threshold of 21.5 % PPD risk probability was determined. After PSM, the results showed that the incidence of PPD in the two intervention groups was significantly different from the control group in the high-risk cohort (P < 0.001) but not in the low-risk cohort (P > 0.001). CONCLUSION Our study demonstrated that the XGB algorithm provided a more accurate in prediction of PPD risk, and it was beneficial to receive early intervention for the high-risk groups distinguished by the model.
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Affiliation(s)
- Hao Liu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Anran Dai
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Zhou Zhou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Xiaowen Xu
- Office of Clinical Trials, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Kai Gao
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Qiuwen Li
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Shouyu Xu
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Yunfei Feng
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Chen Chen
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing 210006, China
| | - Chun Ge
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing 210006, China
| | - Yuanjun Lu
- Research and Development Department, Hangzhou Million Happy Deer Co. Ltd, Hangzhou 310012, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing 210006, China.
| | - Saiying Wang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China.
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Ding X, Liang M, Wang H, Song Q, Guo X, Su W, Li N, Liu H, Ma S, Zhou X, Sun Y. Prenatal stressful life events increase the prevalence of postpartum depression: Evidence from prospective cohort studies. J Psychiatr Res 2023; 160:263-271. [PMID: 36889197 DOI: 10.1016/j.jpsychires.2023.02.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
Postpartum depression (PPD) occurs frequently among postpartum women. Stressful life events (SLE) have gradually been recognized as risk factors for PPD. However, research on this topic has produced equivocal results. The purpose of this study was to explore whether women who experienced prenatal SLE had a higher prevalence of PPD. Electronic databases were systematically searched until October 2021. Only prospective cohort studies were included. Pooled prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using random effects models. This meta-analysis included 17 studies involving 9822 individuals. Women who experienced prenatal SLE had a higher prevalence for PPD (PR = 1.82, 95%CI = 1.52-2.17). In subgroup analyses, a 112% and 78% higher prevalence of depressive disorders (PR = 2.12, 95%CI = 1.34-3.38) and depressive symptoms (PR = 1.78, 95%CI = 1.47-2.17) were detected in women who experienced prenatal SLE. The effect of SLE on PPD at postpartum different time points differed: PR = 3.25 (95%CI = 2.01-5.25) for ≤6 weeks, PR = 2.01 (95%CI = 1.53-2.65) for 7-12 weeks, PR = 1.17 (95%CI = 0.49-2.31) for >12 weeks. No obvious publication bias was detected. The findings support that prenatal SLE increase the prevalence of PPD. The effect of SLE on PPD tends to slightly decrease during the postpartum period. Furthermore, these findings highlight the importance of screening for PPD as early as possible, particularly among postpartum women who have experienced SLE.
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Affiliation(s)
- Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Haixia Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Shaodi Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xiaoqin Zhou
- Department of Psychiatry, Chaohu Hospital/Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China; Chaohu Hospital, Anhui Medical University, Hefei, 238000, China; Centre for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
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Motrico E, Bina R, Kassianos AP, Le HN, Mateus V, Oztekin D, Rodriguez-Muñoz MF, Moreno-Peral P, Conejo-Cerón S. Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis. Gen Hosp Psychiatry 2023; 82:47-61. [PMID: 36958130 PMCID: PMC10183436 DOI: 10.1016/j.genhosppsych.2023.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND To date, dozens of systematic reviews (SRs) and meta-analyses (MAs) summarize the effectiveness of preventive interventions for perinatal depression. However, the results are inconclusive, making an urgent need to step up to higher levels of evidence synthesis. AIMS To summarize and compare the evidence from the SR&MA examining the effectiveness of all types of interventions for preventing perinatal depression. METHOD PubMed, PsycINFO, Cochrane Database of Systematic Reviews and OpenGrey were searched from inception to December 2022. We selected SR&MA of randomized controlled trials (RCTs) that compared all types of preventive interventions for perinatal depression with control groups whose outcome was the reduction of depressive symptoms and/or incidence of new cases of perinatal depression (PROSPERO: CRD42020173125). RESULTS A total of 19 SRs and MAs evaluated 152 unique RCTs that included 83,408 women from 26 countries and five continents. The median effect size for any intervention was SMD = 0.29 (95% CI: 0.20 to 0.38). Exercise/physical activity-based, psychological, and any type of intervention showed median effect sizes of 0.43, 0.28 and 0.36, respectively. The degree of overlap among RCTs was slight. According to AMSTAR-2, 79% of them were rated as low or critically low-quality. The strength of evidence, according to GRADE, was poorly reported and, in most cases, was low. CONCLUSIONS Exercise/physical activity-based and psychological interventions have a small-to-medium effect on reducing perinatal depressive symptoms. There is insufficient evidence to conclude that dietary supplements and pharmacological interventions are effective in preventing perinatal depression. There is a need for high-quality SR&MA of RCTs, mainly focusing on universal preventive interventions.
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Affiliation(s)
- Emma Motrico
- Department of Psychology, University Loyola Andalucía, Spain.
| | - Rena Bina
- School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Angelos P Kassianos
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; Department of Nursing, Cyprus University of Technology, 30 Archbishop Kyprianos, Limassol 3036, Cyprus
| | - Huynh-Nhu Le
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Vera Mateus
- Portucalense Institute for Human Development (INPP), Department of Psychology and Education, Universidade Portucalense, Porto, Portugal; Center for Research in Neuropsychology and Cognitive Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Deniz Oztekin
- Department of Obstetrics and Gynecology, İzmir Bakircay University, İzmir, Turkey
| | | | - Patricia Moreno-Peral
- Biomedical Research Institute of Malaga (IBIMA plataforma Bionand), Málaga, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Spain; Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), Spain
| | - Sonia Conejo-Cerón
- Biomedical Research Institute of Malaga (IBIMA plataforma Bionand), Málaga, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Spain
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Roddy Mitchell A, Gordon H, Lindquist A, Walker SP, Homer CSE, Middleton A, Cluver CA, Tong S, Hastie R. Prevalence of Perinatal Depression in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry 2023; 80:425-431. [PMID: 36884232 PMCID: PMC9996459 DOI: 10.1001/jamapsychiatry.2023.0069] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Importance Women who experience depression during or within a year of pregnancy are at increased risk of morbidity and mortality. Although those living in low- and middle-income countries are thought to be at increased risk of perinatal depression, the true prevalence remains unclear. Objective To determine the prevalence of depression among individuals living in low- and middle-income countries during pregnancy and up 1 year post partum. Data Sources MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and the Cochrane Library were searched from database inception until April 15, 2021. Study Selection Studies were included that reported the prevalence of depression using a validated method during pregnancy or up to 12 months post partum in countries defined by the World Bank as low, lower-middle, and upper-middle income. Data Extraction and Synthesis This study followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Two reviewers independently assessed study eligibility, extracted data, and assessed studies for bias. Prevalence estimates were calculated using a random-effects meta-analysis model. Subgroup analyses were performed among women who were considered at increased risk of developing perinatal depression. Main Outcomes and Measures Point prevalence of perinatal depression was the main outcome measured as percentage point estimates with corresponding 95% CIs. Results The search identified 8106 studies, of which data were extracted from 589 eligible studies reporting outcomes of 616 708 women from 51 countries. The pooled prevalence of perinatal depression across all studies was 24.7% (95% CI, 23.7%-25.6%). The prevalence of perinatal depression varied slightly by country income status. The highest prevalence was found in lower-middle-income countries, with a pooled prevalence of 25.5% (95% CI, 23.8%-27.1%; 197 studies from 23 countries including 212 103 individuals). In upper-middle-income countries, the pooled prevalence was 24.7% (95% CI, 23.6%-25.9%; 344 studies from 21 countries including 364 103 individuals) and in low-income countries, the pooled prevalence was 20.7% (95% CI, 18.4%-23.0%; 50 studies from 7 countries including 40 502 individuals). The East Asia and the Pacific region had the lowest prevalence of perinatal depression at 21.4% (95% CI, 19.8%-23.1%) and was significantly increased in the Middle East and North Africa at 31.5% (95% CI, 26.9%-36.2%; between-group comparison: P < .001). In subgroup analyses, the highest prevalence of perinatal depression was found among women who experienced intimate partner violence, at 38.9% (95% CI, 34.1%-43.6%). revalence of depression was also high among women with HIV (35.1% [95% CI, 29.6%-40.6%]) and those who had experienced a natural disaster (34.8% [95% CI, 29.4%-40.2%]). Conclusions and Relevance This meta-analysis found that depression was common in low- and middle-income countries, affecting 1 in 4 perinatal women. Accurate estimates of the prevalence of perinatal depression in low- and middle-income countries are essential in informing policy, allocating scarce resources, and directing further research to improve outcomes for women, infants, and families.
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Affiliation(s)
- Alexandra Roddy Mitchell
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Hannah Gordon
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anthea Lindquist
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Anna Middleton
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Catherine A Cluver
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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Huang S, Xiao M, Hu Y, Tang G, Chen Z, Zhang L, Fu B, Lei J. Attitudes toward seeking professional psychological help among Chinese pregnant women: A cross-sectional study. J Affect Disord 2023; 322:163-172. [PMID: 36400148 DOI: 10.1016/j.jad.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND There exists a gap between the high prevalence of mental health problems and negative attitudes toward seeking professional psychological help among Chinese pregnant women. This study aimed to investigate the attitudes and factors toward seeking professional psychological help among Chinese pregnant women to provide some suggestions for improving pregnant women's psychological help-seeking behaviors. METHODS A total of 1024 pregnant women were recruited. The Chinese version of the Attitude Toward Seeking Professional Psychological Help Scale (ATSPPH) was used to assess the attitudes toward professional psychological help-seeking. Demographic and socio-psychological factors were collected by self-developed questionnaire, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and Patient Health Questionnaire-9 Scale. RESULTS 1006 pregnant women were included in the final analysis. Only 3.7 % of participants chose professionals as their first choice for psychological help-seeking. The attitudes toward seeking professional psychological help were relatively positive, with the highest score of stigma tolerance among four subscales in ATSPPH. Education level, perceived social support, and positive coping style had a positive predictive effect on the four subscales of ATSPPH. Women with prenatal depressive symptoms had a lower score in the subscales of recognition of need for psychotherapeutic help and confidence in mental health practitioner; women with higher scores of negative coping style had a lower score in the subscales of stigma tolerance and interpersonal openness. History of professional psychological help-seeking behaviors was only associated with the subscale of recognition of need for psychotherapeutic help; Maternal age was only associated with the subscale of interpersonal openness. CONCLUSION The attitudes toward seeking professional psychological help were relatively positive among Chinese pregnant women, and stigma tolerance was the significant barrier to professional psychological help-seeking. More attention should be paid to those women with older age, negative coping style, and women with prenatal depressive symptoms.
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Affiliation(s)
- Sasa Huang
- Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Meili Xiao
- Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Ying Hu
- Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Guanxiu Tang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Zhihong Chen
- Pediatric Intensive Care Unit, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Lijuan Zhang
- Department of Emergency Pediatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Bing Fu
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China.
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50
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Wang Y, Zhong W, Zhao A, Szeto IMY, Lan H, Zhang J, Li P, Ren Z, Mao S, Jiang H, Wang P, Zhang Y. Perinatal depression and serum vitamin D status: A cross-sectional study in urban China. J Affect Disord 2023; 322:214-220. [PMID: 36395990 DOI: 10.1016/j.jad.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although vitamin D has been found to be associated with perinatal depression, the results are inconsistent. The aim of this cross-sectional study was to examine the association between vitamin D and PND in Chinese pregnant women and lactating women. METHODS A total of 1773 participants were included, including 907 lactating women and 866 pregnant women. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PND, and those with scores ≥13 were considered to have PND. Serum 25-hydroxyvitamin D concentrations were assessed with high-performance liquid chromatography. RESULTS The prevalence of postpartum depression (PPD) and antenatal depression (AD) were 15.9 % and 9.8 %, respectively. Compared with individuals with sufficient vitamin D, those with vitamin D deficiency were associated with a higher prevalence of PPD in lactating women (OR = 1.71, 95%CI: 1.01-2.88, p = 0.044). The serum 25(OH)D of lactating women was inversely associated with the scores of the factor "depressive mood" of the EPDS (ORper 5 ng/mL = -0.10, 95%CI: -0.19 to -0.01, p = 0.032). No significant association between serum 25-hydroxyvitamin D and AD was observed. LIMITATIONS First, this study is a cross-sectional design, which can only determine associations but not causality. Secondly, this study only included participants from urban areas. Thirdly, there are still some possible confounding factors that have not been considered. CONCLUSION In conclusion, this study suggested a significant association between vitamin D status and PPD; however, the association between vitamin D status and AD was not significant.
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Affiliation(s)
- Yanpin Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Wuxian Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100091, China
| | - Ignatius Man-Yau Szeto
- Yili Maternal and Infant Nutrition Institute, Beijing 100071, China; Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Hanglian Lan
- Yili Maternal and Infant Nutrition Institute, Beijing 100071, China; Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China.
| | - Jian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Zhongxia Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Shuai Mao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Hua Jiang
- School of Nursing, Peking University, Beijing 100191, China
| | - Peiyu Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China.
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